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A Leg to Stand On: Trauma Center Designation and Association with Rate of Limb Salvage in Patients Suffering Severe Lower Extremity Injury
- Source :
- J Am Coll Surg
- Publication Year :
- 2021
-
Abstract
- BACKGROUND: Mangled extremities are one of the most difficult injuries for trauma surgeons to manage. We compare limb salvage rates for a limb-threatening lower extremity injury managed at Level I versus Level II trauma centers (TCs). STUDY DESIGN: We identified all adult patients with a limb-threatening injury who underwent primary amputation or limb salvage (LS) using the American College of Surgeons (ACS) Trauma Quality Improvement Program database at ACS Level I vs. II TCs between 2007 and 2017. A limb-threatening injury was defined as an open tibial fracture with concurrent arterial injury (Gustilo Type IIIc). Multivariable analysis and propensity score matching were performed to minimize confounding by indication. RESULTS: There were 712 records for analysis; 391 (54.9%) LS performed and 321 (45.1%) underwent amputation. The rate of LS was statistically higher among patients treated at Level I TCs versus those treated at Level II TCs (47.4% vs 34.8%, p=0.01). Patients with penetrating injuries (13% vs 9.5%, p=0.046) and tibial/peroneal artery injury (72.9% vs 50.4%, p
- Subjects :
- Adult
medicine.medical_specialty
medicine.medical_treatment
Amputation, Surgical
Article
Fractures, Open
03 medical and health sciences
0302 clinical medicine
Case mix index
Trauma Centers
Humans
Medicine
Peroneal Artery
Abbreviated Injury Scale
business.industry
Trauma center
fungi
Trauma quality improvement program
Vascular System Injuries
Limb Salvage
Surgery
Tibial Fractures
Lower Extremity
Amputation
030220 oncology & carcinogenesis
Propensity score matching
Injury Severity Score
030211 gastroenterology & hepatology
business
Leg Injuries
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- J Am Coll Surg
- Accession number :
- edsair.doi.dedup.....3508c60349051d240441b79ab0dac9ff